Abstract

PURPOSE: Music is a practical, cheap and harmless analgesic and anxiolytic. An increasing number of original studies have been performed investigating its potential application in urology. Our aim was to identify the effect of music on outpatient based urological procedures. METHOD: A systematic review was performed on the effect of using music during all reported outpatient urology procedures including transrectal ultrasound guided prostate biopsy (TRUS), shock-wave lithotripsy (SWL), urodynamic studies (UDS), percutaneous nephrostomy (PCN) tube placement and cystoscopy. Data was included for all randomised trials from 1980 to 2017 and no language restrictions were applied. RESULTS: Sixteen randomised studies were included (1950 patients) where 972 patients (49.8%) were exposed to music during their outpatient procedure. The procedures included TRUS biopsy (4 studies, n=286), SWL (6 studies, n=1023), Cystoscopy (3 studies, n=331), UDS (2 studies, n=210) and PCN (1 study, n=100). All studies incorporated visual analogue score (VAS) for pain measurement. The anxiety scores were measured by State-Trait anxiety Inventory (STAI) in 13 studies and VAS in 2 studies. While 14 of the 16 studies showed a reduction in self-reported pain, a reduction in anxiety was seen in 14 studies. Using music, the overall procedural satisfaction was better in 9 studies and the willingness to repeat the procedure was also higher in 7 studies. Our meta-analysis showed a significant reduction in both VAS and STAI across all studies (p<0.001). CONCLUSION: Our systematic review shows a beneficial effect of music on urology outpatient procedures. Music seems to decrease anxiety and pain and might serve as a useful adjunct to increase procedural satisfaction and willingness to undergo it again. IMPLICATIONS FOR CLINICAL PRACTICE: Music seems to have a beneficial effect on the pain and anxiety on outpatient based procedures, which are carried out with patient awake or under a local anesthetic. The role of music should be acknowledged in future guideline recommendations as an adjunct for such procedures.

Comments
1

That music during SWL can divert the patient’s attention from an unpleasant treatment situation has been observed in several clinical settings.

Although not uniformly reported it seems likely that all patients treated with SWL had music in headphones. This has a double effect. It hopefully gives not only a pleasant music experience, but also a reduction of the noise caused by SW-administration. Both effects are likely to have influenced the result.

In the early days of SWL (with Dornier HM3) we allowed music, according to the patient’s choice, to stream from loudspeakers. This solution was applied because we considered headphones to be vulnerable to contact with water. Without any scientific evidence it was our impression that patients who listened to music found the treatment less unpleasant than those who did not.

I therefore share the conclusion based on the results in this review that music during SWL is beneficial and should be included in the treatment strategy. But it needs to be mentioned that a communication system also should be applied over the headphones to enable easy contact with the patient.

That music during SWL can divert the patient’s attention from an unpleasant treatment situation has been observed in several clinical settings.
Although not uniformly reported it seems likely that all patients treated with SWL had music in headphones. This has a double effect. It hopefully gives not only a pleasant music experience, but also a reduction of the noise caused by SW-administration. Both effects are likely to have influenced the result.
In the early days of SWL (with Dornier HM3) we allowed music, according to the patient’s choice, to stream from loudspeakers. This solution was applied because we considered headphones to be vulnerable to contact with water. Without any scientific evidence it was our impression that patients who listened to music found the treatment less unpleasant than those who did not.
I therefore share the conclusion based on the results in this review that music during SWL is beneficial and should be included in the treatment strategy. But it needs to be mentioned that a communication system also should be applied over the headphones to enable easy contact with the patient.